You are on page 1of 43

This watermark does not appear in the registered version - http://www.clicktoconvert.

com

Subtalar Joint Axis Location and


Rotational Equilibrium Theory of
Foot Function

Kevin A. Kirby, DPM, MS


Journal of the American Podiatric Medical
Association 91(9): 465-487.
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Introduction
More recent theories on foot function

Sagittal Plane Facilitation Model

Rotational Equilibrium Theory


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Primary Weight-bearing Structures


Kirby, Leondorf & Gregorio (1988)

N=100
Anterior Axial Projection of the Foot

Primary anatomical weightbearing structures during closed


kinetic chain gait are the medial calcaneal tubercle and 5th
metatarsal head.
This watermark does not appear in the registered version - http://www.clicktoconvert.com

GRF Normal
This watermark does not appear in the registered version - http://www.clicktoconvert.com

STJ Axis Orientation

• Courses posterior-
lateral-plantar to
anterior-medial-dorsal
• 16° medial to sagittal
plane
• 42° superior to
transverse plane
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Root et al. (1971)


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Root et al. (1971)


This watermark does not appear in the registered version - http://www.clicktoconvert.com
This watermark does not appear in the registered version - http://www.clicktoconvert.com
This watermark does not appear in the registered version - http://www.clicktoconvert.com
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Clinical Assessment of STJ Axis


Position

Kirby KA, Methods of Determination of Positional


Variance in the Subtalar Joint Axis. Journal of the
American Medical Association 1987; 77(5): 28-
234.
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Plantar Parallel Position


This watermark does not appear in the registered version - http://www.clicktoconvert.com

STJA clinical approximation


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Quantification of STJA
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Subtalar Joint Axis Deviation


This watermark does not appear in the registered version - http://www.clicktoconvert.com

STJ Axis Positional Variance

• Within Normal Limits

• Medially-Deviated

• Laterally-Deviated
This watermark does not appear in the registered version - http://www.clicktoconvert.com

STJA Normal Orientation


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Medially Deviated Subtalar Joint


Axis
• medial to the WBR
structures of the foot
• slightly internally
rotated
• ¯ supinatory moment
• present in functional
overpronators
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Medially Deviated STJ Axis


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Internally rotated & medially


translated talus
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Superior view: talar position


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Posterior view convexity


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Common injuries associated with


MD-STJA
• Plantar fasciitis • Medial tibial stress
• Hallux limitus syndrome
• 2nd MTP joint • PFPS
capsulitis • Pes anserinus bursitis
• Abd. Hallucis strain • PT tendonitis and
• Sinus tarsi syndrome tendon dysfunction
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Laterally Deviated STJ Axis

• lateral to WBR
structures of the foot
• slightly externally
rotated
• ¯ pronatory moment
• present in functional
underpronators
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Laterally Deviated STJ Axis


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Externally rotated & laterally


translated talus
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Superior view: talar position


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Posterior view concavity


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Prominent peroneus longus &


brevis tendons
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Common injuries associated with


LD-STJA

• Inversion ankle
sprains
• Peroneal tendonitis
This watermark does not appear in the registered version - http://www.clicktoconvert.com

STJA orientation
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Medial Heel Skive Technique

• Prescribed for a medially-deviated STJA and


injuries associated with same;
• Originally created for children; and
• Appears to be clinically more effective than a
Blake-Inverted or Root Functional design.
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Rationale
Increase Supination Moment

OR

ORF Inferior to Medial Calcaneal Tubercle


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Indications & Contraindications

Indications Contraindications

• pediatric flexible pes • plantar heel pain (heel


planus spur syndrome, plantar
• posterior tibialis heel bursitis or medial
dysfunction calcaneal neuritis)
• higher level of • lateral ankle instability
pronatory control
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Medial Heel Skive Technique

Negative Cast Balancing


Positive Cast Modification
Land marking & Positioning of MHS
Design Parameters
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Essential Landmarks
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Positioning the Skive


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Medial Heel Skive


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Medial Heel Skive Depth


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Shell Parameters

• 3-5mm polypropylene shell


• Extrinsic rearfoot post
• Minimal MLA dressing
• Lateral phalange
• 18mm+ heel cup
This watermark does not appear in the registered version - http://www.clicktoconvert.com

So what?
• This model may provide a new set of subject
inclusion criteria that can be added to existing
parameters;
• Evaluating 3-D moments about the STJA may
provide us with new insights into:
– the mechanism of running injuries,
– orthotic efficacy; and
– shoe prescription.
This watermark does not appear in the registered version - http://www.clicktoconvert.com

Thanks for comin’ out!


This watermark does not appear in the registered version - http://www.clicktoconvert.com

Rotational Equilibrium